Carrie Friedman, NP
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Latest articles
Conditions and diseases
Earlier this summer, I wrote about "summer SAD," the very real worsening of mood, anxiety, agitation, and sleep that some people experience during the hottest and brightest months of the year. After this weekend, I think the conversation needs to…
Earlier this summer, I wrote about “summer SAD,” the very real worsening of mood, anxiety, agitation, and sleep that some people experience during the hottest and brightest months of the year.
After this weekend, I think the conversation needs to go further. Temperatures in the Sacramento area have exceeded 100°F, and over the past several days I have seen multiple previously stable patients experience abrupt and clinically significant psychiatric destabilization.
One patient …
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Extreme heat and psychiatric symptoms: a clinical warning
Conditions and diseases
Oxytocin is frequently reduced to an appealing but misleading nickname: the "love hormone." In reality, oxytocin is a hormone and neuropeptide involved in childbirth, lactation, attachment, stress regulation, social learning, and the brain's response to interpersonal information. Rather than simply…
Oxytocin is frequently reduced to an appealing but misleading nickname: the “love hormone.” In reality, oxytocin is a hormone and neuropeptide involved in childbirth, lactation, attachment, stress regulation, social learning, and the brain’s response to interpersonal information. Rather than simply creating trust or affection, it appears to influence which social signals receive our attention and how strongly we respond to them.
In a safe relationship, greater sensitivity to another person’s face, …
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Oxytocin for autism is the wrong question to ask
Conditions and diseases
Patient details have been changed and combined where necessary to protect privacy. This week, I evaluated two young people who had recently been hospitalized after developing psychosis in the setting of heavy cannabis use. Both had been discharged with serious…
Patient details have been changed and combined where necessary to protect privacy.
This week, I evaluated two young people who had recently been hospitalized after developing psychosis in the setting of heavy cannabis use. Both had been discharged with serious psychiatric diagnoses and multiple medications. Both families were frightened. And in both cases, the central clinical question remained insufficiently answered: Was this the onset of a primary psychiatric disorder, or was …
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Is it cannabis-induced psychosis or bipolar disorder?
Conditions and diseases
When most people hear the words seasonal affective disorder, they picture winter. Dark mornings. Short days. Cold weather. Fatigue. Oversleeping. Wanting to stay under the covers. Only wanting to go out for donuts. But seasonal depression does not always come…
When most people hear the words seasonal affective disorder, they picture winter. Dark mornings. Short days. Cold weather. Fatigue. Oversleeping. Wanting to stay under the covers. Only wanting to go out for donuts.
But seasonal depression does not always come in winter. For some people, summer is the difficult season. And summer-pattern seasonal affective disorder can look very different from the winter depression most of us recognize. Instead of slowing down, …
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Summer seasonal affective disorder hides in plain sight
Conditions and diseases
When a child is diagnosed with ADHD, the conversation is often much narrower. Medication. Maybe a school form. Maybe a vague suggestion to "try therapy." Then parents are sent back into the same exhausted home, the same chaotic mornings, the…
When a child is diagnosed with ADHD, the conversation is often much narrower. Medication. Maybe a school form. Maybe a vague suggestion to “try therapy.” Then parents are sent back into the same exhausted home, the same chaotic mornings, the same homework battles, the same social struggles, the same emotional explosions, and the same school system that often does not know what to do with a child who is bright, …
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How to build an ADHD treatment plan beyond medication
Conditions and diseases
Adult ADHD is real. It is impairing. It is often missed, especially in bright, high-achieving adults, women, and people who learned to compensate for years before finally burning out. But the solution to underdiagnosis cannot be overdiagnosis. We are now…
Adult ADHD is real. It is impairing. It is often missed, especially in bright, high-achieving adults, women, and people who learned to compensate for years before finally burning out. But the solution to underdiagnosis cannot be overdiagnosis.
We are now seeing a second problem emerge: rushed adult ADHD evaluations, often completed in 30 to 60 minutes, sometimes based heavily on a brief questionnaire, followed quickly by stimulant prescribing. The patient …
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Rushed adult ADHD evaluations put patients at risk
Conditions and diseases
One of the hardest parts of practicing psychiatry is that we still cannot reliably predict which medication will work for which patient. A patient comes in struggling with depression. We choose a medication based on symptoms, history, side effect profile,…
One of the hardest parts of practicing psychiatry is that we still cannot reliably predict which medication will work for which patient.
A patient comes in struggling with depression. We choose a medication based on symptoms, history, side effect profile, family history, clinical experience, and sometimes educated guesswork. Then we wait. Sometimes the medication helps quickly. Sometimes it causes side effects. Sometimes nothing happens at all. Then we adjust, augment, switch, …
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Precision psychiatry is finally catching up to medicine
Conditions and diseases
A 59-year-old woman sat tearfully in my office today. She had spent seven weeks on tirzepatide with virtually no weight loss. "How is this possible?" she asked. "I'm eating like a saint." She had struggled with obesity and weight-related frustration…
A 59-year-old woman sat tearfully in my office today. She had spent seven weeks on tirzepatide with virtually no weight loss. “How is this possible?” she asked. “I’m eating like a saint.”
She had struggled with obesity and weight-related frustration for years. Recently divorced, grieving a death in the family, caring for a mentally ill adult daughter, working full time, sleeping poorly, and living with severe anxiety, she described her stress …
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When GLP-1 doesn’t work, look at chronic stress
Conditions and diseases
In clinical practice, it is not uncommon for autistic patients to arrive after years of treatment with a firm conclusion: Psychiatric medications do not work for them. This belief is typically built on multiple medication trials, inconsistent benefit, and often…
In clinical practice, it is not uncommon for autistic patients to arrive after years of treatment with a firm conclusion: Psychiatric medications do not work for them. This belief is typically built on multiple medication trials, inconsistent benefit, and often significant side effects. But the conclusion itself may be misleading. What is often being observed is not true treatment resistance, but a mismatch between standard psychopharmacology and the neurobiology of …
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Why psychiatric medications often fail autistic patients
Conditions and diseases
The 72-year-old woman sitting in front of me had spent nearly a decade anxious. Not ordinary stress, not fleeting worry, but the kind of chronic physiologic anxiety that hijacks sleep, amplifies rumination, tightens the chest, and slowly shrinks a person's…
The 72-year-old woman sitting in front of me had spent nearly a decade anxious. Not ordinary stress, not fleeting worry, but the kind of chronic physiologic anxiety that hijacks sleep, amplifies rumination, tightens the chest, and slowly shrinks a person’s world. For over eight years, she had been treated with escalating doses of bupropion, eventually reaching 450 mg daily, the maximum recommended dose. And I found myself returning to a …
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Psychiatric polypharmacy is a reassessment failure
Conditions and diseases
Bree is an 11 1/2 year-old, 4.2-pound micro mutt who once lived on the streets of Long Beach. She eventually wound up at Long Beach Animal Care Services, where she sat in a crowded cold cement kennel with no bed,…
Bree is an 11 1/2 year-old, 4.2-pound micro mutt who once lived on the streets of Long Beach. She eventually wound up at Long Beach Animal Care Services, where she sat in a crowded cold cement kennel with no bed, no blanket, no toys, and one very sick basset hound with parvovirus. Every dog in that kennel was scheduled to be euthanized on Christmas Eve 2014. If it weren’t for …
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What a tiny dog taught me about the nervous system
Conditions and diseases
A patient in his 20s recently came to see me in a state of severe distress. He described feeling consumed by his thoughts, constantly anxious, unable to function, and deeply exhausted. His sleep had collapsed. His sense of identity felt…
A patient in his 20s recently came to see me in a state of severe distress. He described feeling consumed by his thoughts, constantly anxious, unable to function, and deeply exhausted. His sleep had collapsed. His sense of identity felt lost. He was experiencing persistent passive suicidal thoughts, not because he wanted to die, but because everything felt overwhelming and unrelenting.
Within three days of starting low-dose lithium at 150 milligrams …
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Low-dose lithium treats suicidal ideation safely
Conditions and diseases
She was 16 the first time she noticed it. Milk. From her breasts. No pregnancy. No childbirth. No explanation. She told a provider. Labs were drawn. Her prolactin was elevated. She was told it was "not a big deal." Over…
She was 16 the first time she noticed it. Milk. From her breasts. No pregnancy. No childbirth. No explanation. She told a provider. Labs were drawn. Her prolactin was elevated. She was told it was “not a big deal.” Over the years, multiple providers suggested she must be stimulating her nipples and advised her to stop. She insisted she was not. She felt embarrassed, dismissed, and increasingly reluctant to bring …
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How diagnostic overshadowing delays hyperprolactinemia care
Conditions and diseases
Delirium is one of the most common and most frustrating syndromes we encounter in medicine. It is also one of the most normalized. Up to 30 to 50 percent of hospitalized older adults experience delirium, particularly in intensive care and…
Delirium is one of the most common and most frustrating syndromes we encounter in medicine. It is also one of the most normalized. Up to 30 to 50 percent of hospitalized older adults experience delirium, particularly in intensive care and post-acute settings, yet it is frequently treated as an expected complication rather than a reversible condition with identifiable drivers. We expect it. We document it. We treat around it. And …
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Why thiamine deficiency is a hidden driver of delirium
Conditions and diseases
Autism is typically framed as a neurodevelopmental condition defined by differences in social communication, sensory processing, and behavior. This framing is incomplete. In clinical practice, autistic individuals frequently present with a striking burden of systemic symptoms involving the gastrointestinal tract,…
Autism is typically framed as a neurodevelopmental condition defined by differences in social communication, sensory processing, and behavior. This framing is incomplete. In clinical practice, autistic individuals frequently present with a striking burden of systemic symptoms involving the gastrointestinal tract, cardiovascular regulation, immune signaling, connective tissue, and stress physiology. These are not side notes. They reflect the fact that autism lives within a nervous system that innervates the entire body.
The …
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POTS and autism: the link with GI issues and hypermobility
Conditions and diseases
In functional and integrative psychiatry, patterns start to announce themselves long before they show up in guidelines. Over the past several months in my clinical practice, I have diagnosed celiac disease in multiple young adult men who presented not with…
In functional and integrative psychiatry, patterns start to announce themselves long before they show up in guidelines.
Over the past several months in my clinical practice, I have diagnosed celiac disease in multiple young adult men who presented not with diarrhea, abdominal pain, or weight loss, but with psychiatric and cognitive symptoms: chronic low mood, brain fog, fatigue, poor motivation, memory issues, and anxiety. Neither had prominent gastrointestinal complaints. Both had …
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Celiac disease psychiatric symptoms: When anxiety is autoimmune
Conditions and diseases
When my father-in-law died by suicide, our family did not just lose a person. We lost the gravitational center of a small universe. He was a giant in my eyes. Not because of his curriculum vitae, though his was extraordinary,…
When my father-in-law died by suicide, our family did not just lose a person. We lost the gravitational center of a small universe.
He was a giant in my eyes. Not because of his curriculum vitae, though his was extraordinary, but because of the way he moved through the world: steady, modest, and relentlessly devoted to the people who needed him.
He had survived what should have broken a human being. As …
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Physician suicide: a daughter-in-law’s story of loss and grief
Conditions and diseases
Over the past decade, there has been a marked rise in adolescents and adults seeking autism evaluations. Many of these individuals are intellectually intact, verbally fluent, and professionally capable, yet have lived for decades with persistent social fatigue, sensory sensitivities,…
Over the past decade, there has been a marked rise in adolescents and adults seeking autism evaluations. Many of these individuals are intellectually intact, verbally fluent, and professionally capable, yet have lived for decades with persistent social fatigue, sensory sensitivities, difficulty interpreting unspoken social rules, emotional overwhelm, rigid or all-or-nothing thinking, challenges with transitions, and extensive masking or camouflaging behaviors, all without a diagnosis. When they finally seek clarity, the …
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ADOS-2 Module 4 vs. narrative interviewing in adult autism
Conditions and diseases
When the American Academy of Child and Adolescent Psychiatry released its October 2025 policy statement expanding what counts as valid, evidence-supported autism treatment, it marked a turning point that has been needed for years. For more than a decade, insurance…
When the American Academy of Child and Adolescent Psychiatry released its October 2025 policy statement expanding what counts as valid, evidence-supported autism treatment, it marked a turning point that has been needed for years. For more than a decade, insurance companies pushed a narrow, outdated narrative that applied behavior analysis was the only evidence-based intervention for autism. That narrative was not accurate. It shaped policy, and it left families …
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New autism treatment guidelines expand options for families
Conditions and diseases
Stimulant medications have long been considered the "gold standard" for treating ADHD. When I tell colleagues I don't prescribe them, I often get pushback: "But it's the first-line treatment for ADHD!" In my functional and integrative psychiatry practice, I am…
Stimulant medications have long been considered the “gold standard” for treating ADHD. When I tell colleagues I don’t prescribe them, I often get pushback: “But it’s the first-line treatment for ADHD!” In my functional and integrative psychiatry practice, I am upfront: I do not prescribe stimulants for ADHD. For patients who are interested in stimulant treatment, I provide referrals to trusted colleagues who do. This decision is not about denying …
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Rethinking stimulants for ADHD
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